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Registration Form

We welcome you to join our vibrant parish community at St. Raphael Parish. We stay centered in the Eucharist and are committed to living a faith of welcome, love and service to one another.

Please fill out the form as completely as possible. Feel free to contact the Parish Office at 440-871-1100 with any questions.

Family Information

Last Name

Required*

Household Address

Street 1*

Street 2

City*

State*

Zip*

Phone Number

This is the main contact number for your family.* --

Household Email Address

This is the main email address for your family*

Registration For:
Required*

	New Parishioner
	Current Parishioner, Updated Information

May We Include Your Family Information in a Parish Directory?

Required*

Are you interested in online giving?

	Yes
	No
	I Already Utilize Online Giving with St. Raphael Parish

Online Giving allows you to make regular offertory contributions or special one-time donations without writing checks or worrying about cash. A link to our secure site will be emailed to you.

Head of Household

Name

Title

First Name*

Middle Name

Last Name*

Maiden Name, if Applicable

Cell Phone Number

Required* --

E-mail Address

Required*

Birth Date

Required* //

Gender
Required*

	Male
	Female

Marital Status

Required*

Marriage Date

Sacraments Received
Required*

	Catholic Baptism
	First Communion
	Confirmation

Occupation

Required*

Spouse

Name

Title

First Name

Middle Name

Last Name

Maiden Name

Cell Phone Number

E-mail Address

Birth Date

Gender

	Male
	Female

Sacraments Received

	Catholic Baptism
	First Communion
	Confirmation

Occupation

Child #1

Please include all children, college-age and younger. Upon graduation, they are encouraged to register independently.

Name

First Name

Middle Name

Last Name

Birth Date

Gender

	Male
	Female

Sacraments Received

	Catholic Baptism
	First Communion
	Confirmation

School Attending

Child #2

Name

First Name

Middle Name

Last Name

Birth Date

Gender

	Male
	Female

Sacraments Received

	Catholic Baptism
	First Communion
	Confirmation

School Attending

Child #3

Name

First Name

Middle Name

Last Name

Birth Date

Gender

	Male
	Female

Sacraments Received

	Catholic Baptism
	First Communion
	Confirmation

School Attending

Child #4

Name

First Name

Middle Name

Last Name

Birth Date

Gender

	Male
	Female

Sacraments Received

	Catholic Baptism
	First Communion
	Confirmation

School Attending

Additional Members

	Please list any additional members of your household.
Text (Multiple Lines)		Please list name, date of birth, gender, and sacraments received.

Questions/Comments

Text (Multiple Lines)

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